Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202201222
Jornal Vascular Brasileiro
Original Article

Association between platelet lymphocyte ratio and neutrophil lymphocyte ratio and clinical outcomes following carotid endarterectomy

Associação do índice plaqueta-linfócito e do índice neutrófilo-linfócito com desfechos clínicos após endarterectomia de carótida

Vinicius Adorno Gonçalves; Martin Andreas Geiger; Danilo Augusto Sarti; Ana Terezinha Guillaumon

Downloads: 0
Views: 658

Abstract

Background: Approximately 30% of stroke cases result from carotid disease. Although several risk factors for complications after carotid endarterectomy have been identified, the existence of a biomarker that can estimate postoperative risk in these patients has not yet been proven.

Objectives: This study aimed to investigate correlations between the platelet-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) and postoperative clinical outcomes in patients undergoing carotid endarterectomy.

Methods: A retrospective study was conducted, including 374 patients who underwent carotid endarterectomy between 2002 and 2019 due to moderate to high extracranial internal carotid artery stenosis. Their platelet-lymphocyte ratio and neutrophil-lymphocyte ratios were obtained from the same blood samples.

Results: There was a statistically significant correlation between the PLR and the occurrence of restenosis (p < 0.01) and acute myocardial infarction (AMI) after endarterectomy (p = 0.03). Additionally, there was a statistically significant correlation between the PLR and the combined outcomes stroke and/or AMI and/or death (p = 0.03) and stroke and/or AMI and/or death and/or restenosis (p < 0.01). However, there were no significant correlations between NLR and these outcomes (p = 0.05, p = 0.16).

Conclusions: The platelet-lymphocyte ratio proved to be a useful test for predicting occurrence of strokes, acute myocardial infarctions, and deaths during the postoperative period after carotid endarterectomy. It was also associated with the risk of postoperative restenosis.

Keywords

platelet count, atherosclerosis, carotid stenosis, carotid endarterectomy, mortality

Resumo

Contexto: Aproximadamente 30% dos casos de acidente vascular cerebral (AVC) resultam de doença carotídea. Embora vários fatores de risco para complicações pós-endarterectomia carotídea tenham sido identificados, ainda não foi comprovada a existência de um biomarcador que possa estimar o risco pós-operatório nesses pacientes.

Objetivos: Correlacionar o índice plaqueta-linfócito (IPL) e o índice neutrófilo-linfócito (INL) com os desfechos clínicos pós-operatórios em pacientes submetidos a endarterectomia carotídea.

Métodos: Estudo retrospectivo que incluiu 374 pacientes submetidos a endarterectomia carotídea, entre 2009 e 2019, por estenose extracraniana da artéria carótida interna. O IPL e o INL foram calculados, tendo sido obtidos das mesmas amostras de sangue.

Resultados: Houve correlação estatisticamente significativa entre IPL e presença de reestenose (p<0,01) e infarto agudo do miocárdio (IAM) após endarterectomia (p=0,03). Os desfechos combinados AVC e/ou IAM e/ou óbito e AVC e/ou IAM e/ou óbito e/ou reestenose apresentaram, respectivamente, correlação estatisticamente significativa com o IPL (p=0,03; p<0,01) e não significativa com o INL (p=0,05; p=0,16).

Conclusões: O IPL mostrou-se um teste útil, capaz de predizer os desfechos de AVC e/ou IAM e/ou óbito em pacientes no pós-operatório de endarterectomia carotídea, relacionando-se também com risco de reestenose pós-operatória.
 

Palavras-chave

contagem de plaquetas, aterosclerose, estenose das carótidas, endarterectomia carotídea, mortalidade

References

1 Soylu Aİ, Cortcu SA, Uzunkaya F, et al. The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease. Vascular. 2017;25(3):299-306. http://dx.doi.org/10.1177/1708538116673770. PMid:27770030.

2 Deşer SB, Yucel SM, Demirag MK, Guclu MM, Kolbakir F, Keceligil HT. The association between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and carotid artery stenosis and stroke following carotid endarterectomy. Vascular. 2019;27(6):604-11. http://dx.doi.org/10.1177/1708538119847390. PMid:31046628.

3 Tek M, Çetin MS, Diker E, Çelebi S, Amasyali B, Berkalp B. Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease. Rom J Intern Med. 2019;57(2):159-65. http://dx.doi.org/10.2478/rjim-2018-0040. PMid:30521474.

4 Raffort J, Lareyre F. Regarding “The association between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and carotid artery stenosis and stroke following carotid endarterectomy.”. Vascular. 2020;28(1):3-4. http://dx.doi.org/10.1177/1708538119880389. PMid:31584349.

5 Naylor AR, Ricco JB, Borst GJ, et al. Editor’s choice - management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):3-81. http://dx.doi.org/10.1016/j.ejvs.2017.06.021. PMid:28851594.

6 Bedel C, Selvi F. Association of platelet to lymphocyte and neutrophil to lymphocyte ratios with in-hospital mortality in patients with type a acute aortic dissection. Braz J Cardiovasc Surg. 2019;34(6):694-8. http://dx.doi.org/10.21470/1678-9741-2018-0343. PMid:31545575.

7 Lalosevic M, Markovic AP, Stankovic S, et al. Combined diagnostic efficacy of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Mean Platelet Volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer. Dis Markers. 2019;2019:6036979. PMid:30800188.

8 Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: Interaction effect with disease severity - a retrospective study. BMJ Open. 2019;9(1):e022896. http://dx.doi.org/10.1136/bmjopen-2018-022896. PMid:30782690.

9 Stoltzfus JC. Logistic regression: a brief primer. Acad Emerg Med. 2011;18(10):1099-104. http://dx.doi.org/10.1111/j.1553-2712.2011.01185.x. PMid:21996075.

10 Sidey-Gibbons JA, Sidey-Gibbons CJ. Machine learning in medicine: a practical introduction. BMC Med Res Methodol. 2019;19(1):64. http://dx.doi.org/10.1186/s12874-019-0681-4. PMid:30890124.

11 Kurtul A, Ornek E. Platelet to lymphocyte ratio in cardiovascular diseases: a systematic review. Angiology. 2019;70(9):802-18. http://dx.doi.org/10.1177/0003319719845186. PMid:31030530.

12 Ye M, Qian X, Guo X, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predict severity and prognosis of lower limb arteriosclerosis obliterans. Ann Vasc Surg. 2020;64:221-7. http://dx.doi.org/10.1016/j.avsg.2019.09.005. PMid:31655109.

13 Sarioglu O, Capar AE, Belet U. Relationship of arteriovenous fistula stenosis and thrombosis with the platelet–lymphocyte ratio in hemodialysis patients. J Vasc Access. 2020;21(5):630-5. http://dx.doi.org/10.1177/1129729819894113. PMid:31884875.

14 Mendes BB, Oliveira ACR, Alcântara KC. Comparison of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in normoglycemic and hyperglycemic subjects. Einstein. 2018;17(1):eAO4403. http://dx.doi.org/10.31744/einstein_journal/2019AO4403. PMid:30652737.

15 Mazza MG, Lucchi S, Tringali AGM, Rossetti A, Botti ER, Clerici M. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in mood disorders: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2018;84(Pt A):229-36. http://dx.doi.org/10.1016/j.pnpbp.2018.03.012. PMid:29535038.

16 Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol. 2018;37(1):4-11. http://dx.doi.org/10.23736/S0392-9590.17.03848-2. PMid:28541022.

17 Serra R, Ielapi N, Licastro N, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as biomarkers for cardiovascular surgery procedures: a literature review. Rev Recent Clin Trials. 2021;16(2):173-9. http://dx.doi.org/10.2174/1574887115999201027145406. PMid:33109051.

18 Li L, Ma Y, Geng X-B, et al. Platelet-to-lymphocyte ratio relates to poor prognosis in elderly patients with acute myocardial infarction. Aging Clin Exp Res. 2021;33(3):619-24. http://dx.doi.org/10.1007/s40520-020-01555-7. PMid:32301030.

19 Venermo M, Wang G, Sedrakyan A, et al. Editor’s choice – carotid stenosis treatment: variation in international practice patterns. Eur J Vasc Endovasc Surg. 2017;53(4):511-9. http://dx.doi.org/10.1016/j.ejvs.2017.01.012. PMid:28274551.

20 Baram A, Majeed G, Abdel-Majeed AS. Carotid endarterectomy: neither shunting nor patching technique. Asian Cardiovasc Thorac Ann. 2018;26(6):446-50. http://dx.doi.org/10.1177/0218492318788777. PMid:30005581.

21 Unlu A, Durukan AB. Safe carotid endarterectomy: “one fits all strategy. Kardiochir Torakochirurgia Pol. 2020;17(3):137-42. http://dx.doi.org/10.5114/kitp.2020.99077. PMid:33014089.

22 Kondo T, Ota N, Göhre F, et al. High cervical carotid endarterectomy–outcome analysis. World Neurosurg. 2020;136:e108-18. http://dx.doi.org/10.1016/j.wneu.2019.12.002. PMid:31830599.

23 Reddy RP, Karnati T, Massa RE, Thirumala PD. Association between perioperative stroke and 30-day mortality in carotid endarterectomy: a meta-analysis. Clin Neurol Neurosurg. 2019;181:44-51. http://dx.doi.org/10.1016/j.clineuro.2019.03.028. PMid:30986726.

24 Gaba K, Ringleb PA, Halliday A. Asymptomatic carotid stenosis: intervention or best medical therapy? Curr Neurol Neurosci Rep. 2018;18(11):80. http://dx.doi.org/10.1007/s11910-018-0888-5. PMid:30251204.

25 Cao D, Chandiramani R, Capodanno D, et al. Non-cardiac surgery in patients with coronary artery disease: risk evaluation and periprocedural management. Nat Rev Cardiol. 2021;18(1):37-57. http://dx.doi.org/10.1038/s41569-020-0410-z. PMid:32759962.

26 Tateosian VS, Richman DC. Preoperative cardiac evaluation for noncardiac surgery. Anesthesiol Clin. 2018;36(4):509-21. http://dx.doi.org/10.1016/j.anclin.2018.07.003. PMid:30390775.

27 Halazun HJ, Mergeche JL, Mallon KA, Connolly ES, Heyer EJ. Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients. J Vasc Surg. 2014;59(3):768-73. http://dx.doi.org/10.1016/j.jvs.2013.08.095. PMid:24571940.

28 King AH, Kim AH, Kwan S, et al. Elevated neutrophil to lymphocyte ratio is associated with worse outcomes after carotid endarterectomy in asymptomatic patients. J Stroke Cerebrovasc Dis. 2021;30(12):106120. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106120. PMid:34597986.
 


Submitted date:
09/15/2022

Accepted date:
06/16/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
64e7bb97a953957a020d22c5 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections